6 European Country Project (EUREST-PLUS)

The main objective of EUREST-PLUS is to monitor and evaluate the impact of the Tobacco Products Directive (TPD) within the context of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) ratification at a European level. For complete information about this project, please go to http://ensp.network/eurest-plus/.


EUREST-PLUS team, April 4, 2016 in Brussels, Belgium

The EUREST-PLUS Project will perform 4 central tasks:

1) create and follow up a longitudinal cohort study of smokers in 6 European Union (EU) Member States (MS) as part of The ITC 6 European Country Project (ITC 6E) (Germany, Greece, Hungary, Poland, Romania, and Spain);

2) perform cross-country analyses: (a) across the 6 participating countries; (b) incorporating the other 3 ITC countries within the EU (France, The Netherlands, and The United Kingdom); and (c) across the broader set of 16 other countries of the ITC Project outside the EU;

3) monitor progress in FCTC implementation through secondary analyses of Eurobarometer surveys; and

4) evaluate changes in product design and its linkages with population use indexes. Thus our main objective is addressed through five integrated research-oriented work packages in EUREST-PLUS.

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Our 4 specific objectives hence are as follows:

  • To evaluate the psychosocial and behavioral impact of TPD implementation and FCTC implementation, through the creation of a longitudinal cohort of adult smokers in 6 EU MS (Germany, Greece, Hungary, Poland, Romania, and Spain; total n=6000) in a pre- vs. post-TPD study design (Work Package (WP) 2&3). Moreover, these evaluation studies of the impact of the TPD and FCTC will be conducted with respect to vulnerable populations, including low-income/socio-economic status (SES) groups and those smokers with respiratory co-morbidities (and/or those with pre-morbid symptomatology). Another important topic that will be addressed in the scientific studies of the ITC 6E cohorts will be a focus on e-cigarettes, addressing basic issues of transition rates from cigarettes to e-cigarettes vs. dual use vs. reversion back to cigarettes vs. quitting all nicotine products. Studies that examine e-cigarettes will be linked to additional analysis, focussing on product testing of various design features of e-cigarettes systematically procured in those same 6 countries where the ITC 6 European Country Surveys will be conducted.

  • To assess support for TPD implementation through secondary dataset analyses of the 2015 Special Eurobarometer on Tobacco Survey (SETS), a cross-sectional survey performed among 27,000 adults in all 28 EU MS, before the TPD is implemented, and to monitor progress in FCTC implementation in the EU over the past years through trend analyses on the merged datasets of the 2009, 2012 and 2015 SETS datasets (n=80,000), with a special focus on vulnerable populations (youth, minorities, unemployed, etc.) (WP5)

  • To document changes in e-cigarette product parameters (technical design, labelling/packaging and chemical composition) following TPD implementation of Article 20 of the TPD. (WP6)

  • To enhance innovative joint research collaborations on chronic, non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and in vulnerable populations in high-income countries (HICs), a key priority of the Global Alliance for Chronic Disease (GACD) outlined in the call. We will specifically address these cross-country analyses through the pooling and comparisons across both other EU countries of the ITC Project (6E, UK, France, Netherlands), and other non-EU countries from LMICs and HICs from the global ITC Project (including key countries of comparison such as Australia, Canada, New Zealand, United States, China). (WP4)

​The activities of the five research-oriented work packages in fulfilling these objectives will be facilitated by an administrative work package (WP1), and by a specific work package dedicated to planning and implementing targeted dissemination activities to maximize the impact of research findings of the EUREST-PLUS Project (WP7). New knowledge produced will be disseminated through multiple avenues targeted at the general public, the media, researchers, patient networks and policy makers.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme (grant agreement No 681109) and the University of Waterloo.


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